目的 探讨超声弹性成像联合高频超声在甲状腺乳头状癌诊断中的应用价值。方法 2022年1月—2023年6月选择在中国人民解放军联勤保障部队第九九〇医院诊治的疑似甲状腺乳头状癌患者82例,所有患者均给予超声弹性成像联合高频超声检查,记录超声特征。所有患者均行病理检查,并以病理检查作为判断的金标准。结果 在82例患者中,病理诊断为甲状腺乳头状癌48例（癌性组）,占比58.54%;甲状腺良性结节34例（良性组）,占比41.46%。癌性组的形态异常、后方回声衰减、钙化、晕环征、边界不清晰、内部低回声等超声征象占比为81.25%、83.33%、83.33%、83.33%、81.25%、81.25%,高于良性组的52.94%、47.06%、47.06%、41.18%、47.06%、52.94%（P<0.05）。癌性组的收缩期最高流速低于良性组（P<0.05）,阻力指数、搏动指数与良性组相比有提高（P<0.05）。癌性组的弹性成像评分多为3~4分,良性组多为2分,两组比较差异有统计学意义（P<0.05）。超声弹性成像联合高频超声判断为甲状腺乳头状癌47例,诊断中的灵敏度与特异度分别为97.92%（47/48）和100.00%（34/34）。结论 甲状腺乳头状癌在超声上多表现为血流信号异常、钙化、后方回声衰减、晕环征等特征,超声弹性成像评分多为3~4分,超声弹性成像联合高频超声在其诊断中具有较高的应用价值。

Objective To explore the application value of ultrasound elastography combined with high-frequency ultrasound in the diagnosis of papillary thyroid cancer（PTC）．Methods From January 2022 to June 2023,82 patients with suspected PTC were treated at Chinese People’s Liberation Army Joint Logistics Force 990 Hospital．All patients were given ultrasound elastography combined with high-frequency ultrasound examination to record ultrasound features．All cases were given pathological examination,and the pathological examination were used as the gold standard for diagnosis．Results Among the 82 patients,48 were PTC（cancerous group）,accounting for 58.54%;and the other 34 were benign thyroid nodules（benign group）,accounting for 41.46%．The proportion of morphological abnormalities,posterior echo attenuation,calcification,halo ring signs,unclear boundary and internal hypoechoics in cancerous group were 81.25%,83.33%,83.33%,83.33%,81.25% and 81.25%,which were significantly higher than 52.94%,47.06%,47.06%,41.18%,47.06% and 52.94% in the benign group（P<0.05）．The highest systolic flow velocity in the cancerous group was significantly less than that in the benign group（P<0.05）,and the resistance index and pulse index were also significantly higher compared with the benign group（P<0.05）．The elastography score were mostly 3~4 in the cancerous group and 2 in the benign group,with a significant difference between the two groups（P<0.05）．Forty-seven cases of PTC were diagnosed by ultrasound elastography combined with high frequency ultrasonography,and the sensitivity and specificity in diagnosis were 97.92%（47/48）and 100.00%（34/34）,respectively．Conclusions PTC is often characterized by abnormal blood flow signals,calcification,posterior echo attenuation,halo sign and so on．The ultrasound elastography score is usually 3~4 points．Ultrasonic elastography combined with high frequency ultrasound has high value in diagnosis of PTC．

目的 分析宫颈弹性成像(UE)参数在宫颈机能不全(CIC)孕妇妊娠结局中的预测价值。方法 选取我院收治的119例(2019年10月—2021年8月)CIC孕妇,根据妊娠结局分为早产组(孕周＜37周)56例、正常组(孕周≥37周)63例,均于孕20～24周接受阴道超声、宫颈UE检查,获取宫颈长度(CL)、宫颈UE参数[超声弹性对比指数(ECI)、宫颈外口弹性应变率(EOS)、宫颈内口弹性应变率(IOS)]并进行比较,以了解宫颈UE参数在CIC孕妇妊娠结局中的应用价值。结果 早产组CL水平较正常组低,ECI、IOS、EOS水平较正常组高(P＜0.05);单因素分析发现,CL、ECI、IOS、EOS均可对CIC孕妇妊娠结局产生影响(P＜0.05);受试者工作特征(ROC)曲线结果显示,CL、ECI、EOS、IOS预测CIC孕妇早产的AUC分别为0.616、0.765、0.728、0.814,敏感度分别为64.29%、75.00%、73.21%、82.14%,特异度分别为42.86%、52.38%、57.14%、42.86%。结论 宫颈UE参数能有效反映宫颈组织情况,对CIC孕妇妊娠结局具有一定的预测价值。

目的 探讨子宫瘢痕的超声弹性成像结合厚度分析对剖宫产后再妊娠产妇子宫破裂的预测应用。方法 选择2020年1月—2021年12月在中山市中医院分娩的剖宫产术后再次妊娠经阴道分娩（VBAC）产妇作为研究对象。根据纳入和排除标准,共纳入子宫破裂的VBAC产妇32例、非子宫破裂的VBAC产妇90例。通过住院病历信息系统查询研究对象的基本信息及其在妊娠晚期（≥37周）用B超对研究对象行子宫瘢痕厚度和弹性的测量结果,采用受试者工作特征曲线（ROC）曲线分析子宫瘢痕厚度和弹性SI值对子宫破裂的预测作用。结果 子宫破裂组中年龄>35岁、妊娠>2次、与上次剖宫产间隔<2年、新生儿体质量≥3 kg、单层缝合者的比例高于非子宫破裂组（P<0.05）。122例产妇子宫瘢痕厚度的均值为（3.42±0.49）mm,SI的均值为（2.57±0.45）。ROC曲线分析结果显示：子宫瘢痕厚度单独预测子宫破裂的曲线下面积（AUC）为0.805（95%CI：0.730~0.880,P<0.05）,cut off值为3.05 mm,灵敏度为0.726,特异度为0.910,约登指数为0.636;子宫瘢痕SI单独预测子宫破裂的AUC为0.730（95%CI：0.635~0.824,P<0.05）,cut off值为2.11,灵敏度为0.767,特异度为0.781,约登指数为0.548;子宫瘢痕厚度联合预测子宫破裂的AUC为0.874（95%CI：0.812~0.937,P<0.01）,灵敏度为0.875,特异度为0.811,约登指数为0.686。子宫瘢痕厚度结合子宫瘢痕SI值预测子宫破裂的AUC高于单独使用子宫瘢痕厚度（Z=7.611,P=0.041）和子宫瘢痕SI值（Z=25.864,P=0.025）。结论 子宫瘢痕的超声弹性成像SI值联合子宫厚度可有效提高超声对于VBAC产妇子宫破裂的预测效能,具有一定的应用意义。

Objective To study the application of ultrasound elasticity imaging combined thickness analysis of uterine scar in predicting uterine rupture in women pregnant after cesarean section．Methods Pregnant women with vaginal birth after cesarean（VBAC）from January 2020 to December 2021 in Zhongshan Hospital of Traditional Chinese Medicine were selected as the research subjects．A total of 32 VBAC parturients with uterine rupture and 90 VBAC parturients without uterine rupture were included according to the inclusion and exclusion criteria．The basic information of the subjects was queried through the medical record information system of the hospital．In the third trimester（≥37 weeks）,the thickness and elasticity of uterine scar were measured by ultrasound,and the predictive effect of uterine scar thickness and elastic SI value on uterine rupture was analyzed by ROC curve．Results Chi-square test showed that the incidence of uterine rupture was higher in patients with age>35 years,pregnancy>2 times,interval from last cesarean section<2 years,newborn weight≥3kg,and the proportion of uterine rupture in single suture was higher than that in double suture（P<0.05）．The mean uterine scar thickness of 122 subjects was（3.42±0.49）mm,and the mean SI was（2.57±0.45）．The area under curve（AUC）of uterine scar thickness alone for predicting uterine rupture was 0.805（95%CI：0.730-0.880,P<0.05）,the cut off value was 3.05 mm,the sensitivity was 0.726,the specificity was 0.910,and the Youden coefficient was 0.636 by ROC curve analysis．The AUC of uterine scar SI alone for predicting uterine rupture was 0.730（95%CI：0.635-0.824,P<0.05）,the cut off value was 2.11,the sensitivity was 0.767,the specificity was 0.781,and the Youden coefficient was 0.548 by ROC curve analysis．The AUC of uterine scar thickness combination for predicting uterine rupture was 0.874（95%CI：0.812-0.937,P<0.01）,the sensitivity was 0.875,the specificity was 0.811,and the Youden coefficient was 0.686 by ROC curve analysis．The AUC predicted by uterine scar thickness combined with uterine scar SI value was higher than that predicted by uterine scar thickness alone（Z=7.611,P=0.041）and uterine scar SI value（Z=25.864,P=0.025）．Conclusions Elastic SI value of ultrasound imaging of uterine scar combined with uterine thickness can effectively improve the prediction efficiency of ultrasound for VBAC maternal uterine rupture,which has certain application significance,but further demonstration is still needed．

目的 探讨实时超声弹性成像技术联合常规超声检查在评估脑卒中患者颈动脉粥样硬化斑块稳定性中的临床应用价值。方法 收集我院收治的临床确诊脑卒中患者(卒中组)34例作为研究对象,另抽取同期存在颈动脉斑块但未发生过脑卒中的人群(对照组)56例作为对照研究对象,进行超声弹性成像检测,并对检查结果进行统计分析。结果 34例脑卒中患者发现颈动脉粥样硬化斑块57个,其中低回声斑块29个,混合回声斑块21个,强回声斑块7个;56例对照组患者发现颈动脉粥样硬化斑块75个,其中低回声斑块22个,混合回声斑块25个,强回声斑块28个;两组间比较斑块数量之间、斑块大小之间差异有统计学意义(P<0.05)。颈动脉粥样硬化低回声、混合回声及强回声斑块弹性评分依次升高,其斑块硬度值依次升高;两组间斑块的评分数量分布差异有统计学意义(P<0.05);对于同一类型斑块的硬度值两组间差异无统计学意义(P>0.05);脑卒中组不同类型斑块间的硬度值差异有统计学意义(P<0.05)。结论 超声弹性成像技术可对脑卒中患者颈动脉粥样硬化斑块的稳定性进行半定量评估,不同类型斑块因所含组织成分的不同其弹性应变率表现也不同,能有效补充常规超声检查的信息的不足,进而评估斑块的稳定性。

Objective To explore the clinical value of real-time ultrasound elastography combined with conventional ultrasound in assessing the stability of carotid atherosclerotic plaques in stroke patients. Methods Thirty-four patients with clinically confirmed stroke (stroke group) in our hospital were collected as the research object. Another 56 patients with carotid plaque but without stroke (control group) in the same period were selected as the control object for ultrasonic elastography detection, and the results were analyzed statistically. Results Thirty-four stroke patients were found 57 carotid atherosclerotic plaques, including 29 hypoechoic plaques, 21 mixed echoic plaques and 7 hyperechoic plaques; 56 control patients were found 75 carotid atherosclerotic plaques, including 22 hypoechoic plaques, 25 mixed echoic plaques and 28 hyperechoic plaques. There were significant differences between the number of plaques and the size of plaques (P<0.05). Carotid atherosclerosis low echo, mixed echo and strong echo plaque elasticity score increased in turn, the plaque hardness value increased in turn; the number of plaque scores between the two groups had statistical significance (P<0.05); for the same type of plaque hardness value between the two groups had no significant difference (P>0.05); There were significant differences in hardness values between the same types of plaques (P<0.05). Conclusion Ultrasound elastography may semi-quantitatively evaluate the stability of carotid atherosclerotic plaques in stroke patients. Different types of plaques have different elastic strain rates because of different tissue components. It may effectively complement the information deficiency of conventional ultrasound examination, and then evaluate the stability of plaques.

目的 构建吉西他滨耐药乳腺癌细胞4T1耐药株并建立裸鼠乳腺癌肝转移模型。方法 采用低浓度加量持续诱导法,诱导吉西他滨耐药乳腺癌细胞4T1耐药株,命名为4T1/Gem;CCK-8法测定4T1与4T1/Gem细胞的增殖抑制率,计算耐药指数; Western blot法检测细胞P-gp蛋白表达;B超引导下注射4T1/Gem细胞悬液诱导裸鼠肝脏成瘤;HE染色观察肿瘤组织病理情况,免疫组化法检测瘤组织ER、PR、HER2、Ki-67和P-gp蛋白的表达。结果 经过14个月的诱导成功建立4T1/Gem细胞株,可在含40 μg/mL的Gem培养液中稳定生长。4T1/Gem细胞耐药指数为4T1细胞的788.547倍。与亲代相比,4T1/Gem处于G1期和G2期的细胞增加,S期细胞减少;上调P-gp蛋白的表达。4T1/Gem细胞成功建立裸鼠乳腺癌肝转移模型,瘤组织中ER、PR、HER2蛋白阴性表达,Ki-67阳性10％和P-gp蛋白阳性表达。结论 成功构建吉西他滨耐药乳腺癌细胞4T1耐药株并建立裸鼠乳腺癌肝转移模型,为开发治疗乳腺癌肝转移化疗耐药的药物提供实验基础。

Objective To construct a gemcitabine-resistant variant of the breast cancer cell line (4T1/Gem) and establish a nude mouse model of breast cancer with hepatic metastatic. Methods A gemcitabine-resistant variant of the breast cancer 4T1 cell line was induced by gradually increasing the concentration of gemcitabine; this variant is referred to in this study as 4T1/Gem. The proliferation suppression rates of 4T1 and 4T1/Gem cells were determined by using the CCK-8 essay to evaluate the drug resistance indices of the cell lines. Western blot analysis was used to detect P-gp protein expression. Under ultrasonography, a 4T1/Gem cell suspension was injected into nude mice to induce liver tumors. H&E staining was used to observe tumor pathology, and immunohistochemistry was used to detect the expression of ER, PR, HER-2, Ki-67, and P-gp. Results After 14 months of induction, a 4T1/Gem cell line is established successfully. The cell line can grow stably in culture liquid containing 40 μg/ml gemcitabine. The drug resistance index of 4T1/Gem is 788.547. Compared with the 4T1 cell line, the 4T1/Gem cell line can upregulate P-gp protein expression and successfully establish a nude mouse model of breast cancer with hepatic metastatic. ER, PR, and HER-2 proteins exhibit negative expression in the tumor tissue. The positive expression of P-gp and 10% of Ki-67 proteins is also observed. Conclusion This study successfully constructs a gemcitabine-resistant variant of the breast cancer cell line (4T1/Gem)and establishes a nude mouse model of breast cancer with hepatic metastatic, thereby providing an experimental basis for developing and treating a drug-resistant variant of breast cancer.